All PlansCoverageMedium impact
Reimbursement Policy Updates: Effective December 1, 2020
Healthfirst·Family Medicine, Internal Medicine, Podiatry +2 more·Provider Update
Effective date
Dec 1, 2020
We identified it
Jun 20, 2026
Summary
Healthfirst has implemented stricter reimbursement policies for four specific service areas: folate testing limited to once yearly (except deficiency cases), hyperkeratotic lesion paring requires additional diagnoses, nail plate avulsion limited to once per 12 weeks, and chest X-rays require pertinent symptoms or diseases. These changes align with CMS guidelines and will result in claim denials if not followed.
Action Required
By December 1, 2020: Billing team must update system edits to flag folate testing (82746) more than once yearly, require additional diagnoses for hyperkeratotic lesion codes (11055-11057), limit nail avulsion codes (11730, 11732) to once per 12 weeks, and require symptom diagnoses for chest X-rays (71045, 71046). Update encounter forms and train providers on new documentation requirements. Claims not meeting these criteria will be denied.